This invention relates to neurosurgical apparatus generally, and more particularly, to an improved apparatus for supporting an upper torso and head of a patient.
With current medical practices, it is common for a patient to undergo a diagnostic scanning procedure, which is normally performed in a separate suite containing the scanning machine and dedicated to scanning procedures. The scanning machine may be a CT, MRI, or other scanning device. Thereafter, the scan data is utilized in a surgical planning process, which conventionally takes place at a location, for example, an office or an operating room. In some surgical procedures, the scanning data is utilized with a system for post processing the scan data acquired during imaging. Further, the imaging system may be located in a surgical suite, and the surgical planning performed before and during a surgical procedure utilizing the imaging system and scan data.
During the scanning procedure, the patient must maintain a perfectly still and motionless posture, and while most often, the patient simply lies on a scanning support table, in some situations, the patient may be supported in the desired scanning position with pads, straps or other supports. Further, the support on which the patient rests is normally radiolucent, that is, transparent to the scanning device, so that the support does not compromise the utility of the scanned image. Further, the patient support used for scanning normally translates with respect to the imaging device. Translation of the patient support permits the patient to be moved into the scanning field or zone of the scanning machine.
After the scanning process is completed, often the patient is then moved to an operating room which requires either that the patient walk, or be carried, for example, by transferring the patient from the scanning table to an operating table. Alternatively, as illustrated in U.S. Pat. No. 5,475,884, the patient may be supported on a portable support plate, which is easily moved between the scanning table and the operating table. The scan data is often used in a post processing imaging system for surgical planning purposes both prior to and during surgery. If during or after a surgical process, it is desired to scan a patient again, the patient must be moved from the operating room to the scanning suite, transferred to and from the operating table to the scanning table, and after scanning, transferred back to the operating table and returned to the operating room. The above process is cumbersome, time consuming and potentially risky for the patient.
Some newer scanning machines are substantially reduced in size. One such machine is shown in FIGS. 2 and 3 of U.S. Pat. No. 5,499,415, which show an annular-shaped scanner mounted on a wheel-supported frame, to enable the scanner to be used at multiple sites. Consequently, such scanning machines do not require their own suite or room, but instead, they may be used within the operating suite itself. Thus, in an operating room, the patient may be scanned; the surgical planning performed; an operative procedure executed; and the patient scanned again to determine the current status of the operative procedure. Based on the new scanned images obtained from the one or more xe2x80x9cintraoperativexe2x80x9d scans, the operative procedure can be continued and the above process repeated as necessary.
A limitation of the current state-of-the-art is that the posture of the patient during the scanning process is often different from the patient""s posture during surgery. If a patient is positioned in one posture on a scanning table during the scanning process, and then is moved to an operating table, that motion of the patient may cause the position of the target to change with respect to the body surface. During surgery, this problem is compounded by tissue shifts attendant to the opening of body cavities, removal of body fluid or tissues and tissue retractions. Thus, while such motion may be small, any motion of the target will reduce or compromise the utility of the preoperative scan data.
The solution to these problems is to scan the patient in the operating room during surgery while the patient is maintained in the surgical posture, and further, to make successive intraoperative scans, as necessary, while still holding the patient in the same surgical posture.
While current scanning tables are radiolucent and provide a translation to move the patient into the scanning machine, such scanning tables do not have the accessories required to attach, support and stabilize surgical instrumentation and to properly support the patient""s body in the desired surgical posture. Further, as presently known, scanning tables cannot be used as operating tables, and generally, operating tables are inappropriate for use as scanning tables.
Further, after a patient has been placed on an operating table, the patient""s head is then mounted in a stabilization device, for example, a skull clamp. It is essential that the surgeon be able to position the patient very accurately. Minor changes in patient position have major consequences for optimal access and visualization during surgery. Different positions and orientations of the patient""s head relative to the skull clamp often requires that patient""s whole body be moved. Therefore, there is a need to be able to adjust the position and orientation of the patient""s head with respect to the patient stabilization device without having to move the patient""s body.
Consequently, there is a need to overcome the above-described problems and support a patient in a desired position in a manner which readily accommodates successive surgical and scanning procedures as well as intraoperative scans.
The present invention provides a variable length surgical table extension that is more flexible than known devices. The variable length surgical table extension of the present invention allows a patient stabilization device to be moved in many degrees of freedom including along a length of the table extension. Thus, a surgeon can easily and accurately position and orient a patient""s head in the stabilization device independent of the patient""s body position; and hence, minor adjustments of the patient""s head with respect to the stabilization device can be made without having to move the patient""s whole body. The variable length surgical table extension of the present invention is especially advantageous for use in neurosurgery and spinal surgery as well as intraoperative scanning procedures.
In accordance with the principles of the present invention and the described embodiments, a surgical table extension has a radiolucent inner support member removably attached to a longitudinal end of a surgical table and extending outward from the longitudinal end in cantilever fashion. A radiolucent outer support member is mounted to the inner support member, and the outer support member is adjustable with respect to the inner support member to change a length of the table extension. The surgical table and the table extension are movable relative to the scanning machine to locate the table extension within a scanning zone of a scanning machine.
In one aspect of the invention, a radiolucent patient stabilization device, such as a radiolucent skull clamp or a radiolucent horseshoe headrest, is supported by the outer support member.
Various additional advantages, objects and features of the invention will become more readily apparent to those of ordinary skill in the art upon consideration of the following detailed description of the presently described embodiments taken in conjunction with the accompanying drawings.